Complex Knee Injury Overview
While it is most common for an injury to the knee to involve a single ligament (Aneterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL), or Posterolateral Complex (PLC)) there are severe injuries that may involve a tear in two or more ligaments. Of the four major ligaments listed above, the ACL and PCL are known as the “cruciate ligaments” since the cross over each other. These run inside the knee joint and provide anterior/posterior (front/back) stability in addition to stabilizing the knee with rotation. The MCL and PLC run mostly on the outside of the knee and function predominately in side to side movement in addition to rotation. These ligaments work together to make everyday motions and movements possible for the knee and provide stability throughout a range of motion.
When a ligament is stressed beyond its normal strength, it will partially or fully tear. The types of accidents which may cause damage to more than one ligament in the knee are typically high energy events such as a direct hit to the knee during sports, severe falls, car accidents, and other major trauma. When more than one ligament becomes injured, the knee becomes very unstable and is susceptible to serious injury. This is why a multi-ligament knee injury necessitates immediate and proper medical attention. When more than one ligament is torn the knee may subluxate or fully dislocate (move out of joint). When this happens the important arteries and nerves running around the knee are placed at risk of injury. Complex knee surgeon, Dr. Robert Boykin focuses on the treatment of multi-ligament knee injuries for patients in Asheville, Arden, Fletcher and surrounding North Carolina communities.
Symptoms of a Multi-Ligament Knee Injury
The most common symptoms associated with a multi-ligament injury are immediate pain and difficulty moving the knee. Other symptoms may include:
- Swelling and bruising within a short period of time following the injury are
- A total lack of stability when attempting to put weight on the leg or move the leg
- In extreme cases a patient may note numbness, tingling, weakness, or coolness in the leg which should be evaluated immediately by a medical professional as this may signify an injury to the nerves or blood vessels in the leg.
How to Identify a Multi-Ligament Knee Injury
For patients suffering from multi-ligament knee injuries, it is advised that they seek immediate medical attention because of the risk of more severe injury to the neurovascular structures of the leg. In these cases where the blood supply to the leg is affected, the entire leg may be at risk.
When a patient presents with a multi-ligament injury to the knee, Dr. Boykin will perform a history and physical examination to decide what structures have been injured. If the knee has dislocated, it will be reduced (placed back into joint) immediately. X-rays will be ordered to determine if there is any injury to the bone. An MRI will typically be ordered to assess the ligaments in more detail, and if a vascular injury is suspected, a CT scan with dye will be performed to look at the blood vessels. In cases of vascular injury a consultation with a vascular surgeon will be obtained.
Multi-Ligament Knee Surgery
The vast majority of multi-ligament knee injuries require a complex knee surgery. Depending on which ligaments are injured, Dr. Boykin may recommend immediate surgery to restore stability to the knee and prevent further damage. In other cases the surgery may be delayed to allow swelling to decrease and for the patient to regain some range of motion prior to surgery. During this surgery complete repair or reconstruction of all torn ligaments is performed. Sutures as well as other techniques are used in order to reattach ligaments that may have detached and address ligament or capsular tears that are able to be repaired. For other ligaments a graft, which is typically donated, will be used for reconstruction. Dr. Boykin believes in attempting to perform all of the necessary procedures in one setting when possible.
For more information on multi-ligament knee injuries, or for additional resources on complex knee injuries involving multiple ligaments, please contact Dr. Robert Boykin orthopedic knee surgeon serving Asheville, Arden, Fletcher and surrounding North Carolina communities.